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Malnutrition: Children Still Paying Price, Amid Plenty Of Food

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The small path was wet underfoot. It had just poured. The soil was slippery and the boda boda man I had picked near Kitabi had stopped me midway the journey when it was clear his tyres could not keep up with the very greasy terrain. So, I had to walk. This gave me the chance to take clearer peers at my surroundings. Very well-tended to banana (matooke) plantations. I was in a middle of like seven hectares of bananas. The foliage looked so beautiful, me on this winding path, until it ushered me into a compound and suddenly all the beauty was gone.

Set, almost in the centre of the banana plantation in this village, was a small mud and wattle house; with perhaps one bedroom, a living room and another room which acted as a store. The compound was equally wet and slippery and looked untrodden. There didn’t seem any sign of life here. As I stood stunned, contemplating whether to turn back, suddenly I took in the irony: how can something so inadequate stand at the heart of something so rich? How can dearth thrive amidst plenty?

A part of me wanted to turn and return to the trading centre, where I could hop onto another boda boda to take me to the town I had booked my hotel room. But I had not walked this journey to just abandon my quest. So, I moved closer to shanty house and knocked at its wooden door. There was no response. I knocked again, and waited. Moments later, I heard objects move inside of the house. Then the door shutters push and the door start to open.

Standing in the doorway was a woman, perhaps in her late 30’s. She was in a blouse and some oversize dirty skirt. I learnt her name was Annatoli. She had three children; and was a second wife to her husband, who visited once in a while.

“My husband owns this (house and the hectares of banana plantations). He comes here once or twice a week. So, I stay here with my children,” Annatoli, says. But she’s visibly troubled by something. After a short while, she requests to return inside the house to get a towel to cover the baby, because it’s getting cold. When she returns, she is accompanied by two of her other children. One has a big head, but her eyes look sunken. Her skin texture is thin. She has a ‘pot belly’ and walks with discomfort. The woman seems to notice me noticing her baby, when she offers: “her name is Gift. But she’s sickly. She’s seven years. But one can mistake her to be four.”

“I have taken her to Kitabi (Health Centre IV). Health workers say she is malnourished and stunted and want her put on a special diet which I cannot afford,” says the woman.

But Annatoli and her three children aren’t the only ones suffering from severe malnutrition in this visibly land of plenty.

A 30 minutes’ walk away, twenty-eight-year–old Grace Kyomugisha sits lost in thought as she carries her emaciated baby.

The two-year old can hardly sit or stand without help. The baby’s hair is silky and thin. Her stomach and feet are swollen.

Kyomugisha says six months ago, her baby got a fever and diarrhea followed by gradual loss of weight, swelling of feet and stomach.

Like Annatoli, she’s visited the Kitabi Health Centre IV to find what could be wrong with her baby, but she abandoned the health officers’ prescription after they gave her Oral Rehydration Salts and advised her to feed the child on more than just matooke.

“They said I needed to prepare mushrooms, ground nut soup, beans, greens and other foodstuffs for her (baby) on top of the matooke. But where do we get these other foodstuffs? We only have matooke. A litre of milk (also recommended) costs sh1000. I don’t have that money.”

Edith Mwesiga,the in-charge at the health centre, says Kyomugisha’s baby is “wasted”, which is a form of malnutrition.

“We diagnose lots of these (malnutrition) cases. But parents keep feeding the children on only matooke. We advise them about the importance of eating a balanced diet. But they don’t learn. Because matooke is plenty and almost every homestead has a garden, it is easily the go to food when the family want to prepare a meal,” says the in-charge. “The food (matooke) is so popular. Some folks don’t eat when it is lacking on the menu.”

But these folks need to know matooke contains only a fraction of the necessary nutrients needed to build a strong and healthy body.               

Nutrients in matooke

Umar Mutuya, a food scientist at Makerere University, says Matooke is rich in potassium, but hardly contains any body building proteins. “Matooke is primarily made up of water. For every plate of the dish three-quarters of it comprises water,” he says.

One-fourth is carbohydrates, which the body breaks into simple sugars for energy. One serving of matooke has the same amount of energy calories as a cup of rice or a cup of chopped-up roasted chicken. In order to have a balanced meal, Mutuya advises that matooke should be eaten with foods rich in proteins, or served with meat sauce. 

Despite Uganda’s progress in reducing poverty over the years, malnutrition still ravages the country and affects millions of people, especially women and children. Children under the age of five are prone to Vitamin A deficiency. It is absurd that it is in areas, where food ordinarily shouldn’t be a challenge, where levels of malnutrition are most high.   

A 2016 “Uganda: Nutrition Profile” lists districts in Western Uganda, including Bushenyi, Kibaale, Kisoro and Isingiro as with the highest numbers of stunted, wasted and underweight children. The report indicates that almost four in every 10 children below five years in the districts are malnourished. The western districts were accompanied by the Karamoja region, which posted a 45% prevalence of under-five children who are malnourished. National prevalence stood at 33%.

Children who are malnourished present with fatigue, loss of muscle mass and may illustrate failure to grow or gain weight.

In extreme cases, their skin and hair color and texture may change and they may develop swellings around the ankles, feet and belly, Dr. Sabrina Kitaka, a pediatrician and nutrition expert, says. They may also have diarrhea and, if untreated, the condition may cause a weakened immune system, which can lead to more frequent and severe infections, causing death.

Reports show malnutrition induces almost 50% of under five deaths in the country. 

“Acute malnutrition may cause other health conditions including low sugars in blood, anaemia, and diarrhoea which may cause severe dehydration, skin and sight problems,” say Dr. Elizabeth Nakiboneka at Mulago Hospital.

“Children, especially in rural communities, are malnourished because they don’t strike a balance of the foods they eat. They lack key nutrients like Vitamin A, zinc, iron and others, which are very essential,” she said.

So what?

Boaz Musiimenta, the head of nutrition department in the Office of the Prime Minister, called for communities to be sensitized on food security in their homes and right food combinations that are nutritionally adequate and safe.

“Children’s food must be clean and prepared correctly so that the baby’s body can absorb nutrients,” Agnes Baku Chandia, the head of the nutrition unit at the health ministry, said.

It is the same thing with breast feeding. Statistics show the percentage of babies who are exclusively breast-fed stands at 63% and initiation in the first hour of birth at 53%. But when children are not breast-fed enough and given complementary feeding, they risk being stunted.

Baku Chandia called for mothers to be taught to understand the importance of “good feeding and intensive breast feeding of children” for the first six months after delivery.  

“Proper nutrition starts before conception, continues during pregnancy, after birth and throughout breastfeeding and complementary feeding,” she said.

Baku Chandia implored the Government to implement the National Nutrition Policy, which demands that common staple foods in the country be fortified as a strategy to improve healthy living.

The revised policy highlights that government will promote maternal nutrition and care, including encouraging exclusive breastfeeding for the first six months of life; timely, adequate, safe and appropriate complementary feeding and micronutrient intake between six and 24 months.

By John Agaba and Joshua Kato

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